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Changing parents’ opinions regarding antibiotic use in primary care

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European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Parents’ wish for antibiotics is a significant determinant of antibiotic prescription for their children. The objective of the study was to assess the effect of an educational intervention on parents’ attitudes towards antibiotic use. Parents accompanying their children to primary pediatric clinics of Jerusalem–Hashfela District of Maccabi Healthcare Services responded to a survey regarding their wish for antibiotic treatment. Two groups of parents were surveyed: A (control) in a pre-intervention period and B (intervention) during the intervention period. The intervention included posters, pamphlets, and drawing booklets for children in the waiting rooms. A per-protocol analysis that included from group B only parents that stated they noticed the educational material (B1) was also performed. Eight hundred and sixty-eight parents were surveyed during the pre-intervention period and 688 parents during the intervention period. Children’s median age was 4 years (8 days–16 years). Most (86%) of the parents were mothers. Groups were similar in socio-demographic characteristics and children’s medical complaints. Factors associated with parent’s low expectation for antibiotics were a general negative attitude to antibiotics (OR 1.66, 95% CI 1.20–2.30), current upper respiratory tract symptoms (OR 0.29, 95% CI 0.21–0.39), advanced knowledge regarding antibiotics (OR 1.72, 95% CI 1.26–2.34), and being in group B (intervention) (OR 1.47, 95% CI 1.08–2.00). The effect of the intervention was greater in the per-protocol analysis (OR 1.75, 95% CI 1.20–2.55). A simple educational intervention was effective in reducing parents’ expectation for antibiotics but was significantly more effective when parents reported they noticed the campaign. Improving parents’ knowledge regarding antibiotics can reduce parents’ wish for antibiotic treatment.

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Acknowledgments

The IJAP study group has enabled us to carry out this study. The IJAP study group members: Amzel Shlomo, Bar Joseph, Baraka Surin, Batash David, Ben-Israel Neta, Berkovitch Mattetiahu, Bibi Chaim, Bracher Arie, Broide Joseph, Chernin George, Cohen Adi, Dan Mannana, Gauchman Yehudith, Gross Julian, Hanakuglo Aharon, Hannani Michael, Heipert Joseph, Hetman Shmuel, Kalter Yishaiahu, Kookia Ira, Kroitero Sonel, Leshem Meiron, Likwermann Abraham, Lzdin-Avdaiv Natali, Mor Abraham, Morag Benjamin, Osher Marian, Phoimer Moses, Reznik Svetlana, Ringel Sigal, Rodity Abraham, Roizin Hector, Shamaiv Boris, Shoicet Elena, Shusaiov David, Shiffer Tzvia, Shneidermann Daniel, Stern Ora, Teflitski Ina, Teper Gnadi, Tzimbler Lilly, Vinker Rina, Voll Maya, Yaakovi Tamir, Yafe Solomon, Yakirevitch Liovov, Yofe Marina, Yofe Yuval, Zinger Amihood, Ziselson Alexander.

Conflict of interests

Authors have no conflict of interests.

Author information

Authors and Affiliations

  1. Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, 52621, Israel

    Yasmin Maor, Ethan Rubinstein, Estella Derazne, Galia Rahav & Gili Regev-Yochay

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Yasmin Maor, Ethan Rubinstein, Estella Derazne, Galia Rahav & Gili Regev-Yochay

  3. Jerusalem–Hashfela District, Maccabi Healthcare Services, Jerusalem, Israel

    Meir Raz, Sigal Ringel & Hector Roizin

Authors
  1. Yasmin Maor
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  2. Meir Raz
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  3. Ethan Rubinstein
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  4. Estella Derazne
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  5. Sigal Ringel
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  6. Hector Roizin
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  7. Galia Rahav
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  8. Gili Regev-Yochay
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Consortia

for the Israeli Judicious Antibiotic Prescription (IJAP) study group

Corresponding author

Correspondence to Yasmin Maor.

Appendix. Parent questionnaire

Appendix. Parent questionnaire

  1. 1.

    Birth date of child

  2. 2.

    Does your child suffer from any of the following symptoms today?

    1. a.

      Fever

    2. b.

      Cold (rhinitis)

    3. c.

      Sore throat

    4. d.

      Ear pain

    5. e.

      Diarrhea

    6. f.

      Cough

  3. 3.

    Do you think your child’s current condition requires antibiotic treatment?

  4. 4.

    Will you request the physician an antibiotic prescription today?

  5. 5.

    How many antibiotic courses did your child receive during the last year?

  6. 6.

    In the past, when your child suffered from high fever did you:

    1. a.

      Prefer that he/she will receive antibiotic treatment as soon as possible?

    2. b.

      Prefer that he/she will not receive antibiotics, even at the price of an extra day of illness?

  7. 7.

    In the past, when your child received antibiotics:

    1. a.

      You initially thought that it was required?

    2. b.

      You initially objected, but were convinced by the doctor that it was necessary?

  8. 8.

    In the past, when your child received an antibiotic prescription for 7 days, three doses per day, did you:

    1. a.

      Strictly gave him/her all three doses each day?

    2. b.

      Gave him/her the treatment strictly until the end of the 7th day?

  9. 9.

    In the past, when your child received antibiotic treatment, did the treatment help him/her?

  10. 10.

    Do you agree with the following statement: in case of doubt, it is better to start antibiotics, because even if it will not help it will not harm.

  11. 11.

    Antibiotic treatment is the treatment for:

    1. a.

      Fever

    2. b.

      Against bacteria

    3. c.

      Against flu

    4. d.

      Against viruses

    5. e.

      Against inflammation

  12. 12.

    Antibiotic treatment can cause adverse effects like: allergy, diarrhea, abdominal pain, etc. (True/False)

  13. 13.

    Antibiotic treatment today can result in ineffectiveness of future antibiotic treatments. (True/False)

  14. 14.

    Antibiotic treatment today can result in ineffectiveness of future antibiotic treatment to the child’s siblings. (True/False)

  15. 15.

    Parent’s demographic data: gender, age, number of children, country of origin, date of immigration to Israel, education

For Group B (responding to the questionnaire after the intervention), the following items were added at the end of the questionnaire:

  1. 1.

    Did you notice the poster about antibiotic-resistant bacteria?

  2. 2.

    Did you read it?

  3. 3.

    Did you receive the “Fighting resistant bacteria” pamphlet?

  4. 4.

    Did you read it?

  5. 5.

    Did you receive an explanation about antibiotic treatment or otitis media from the physician?

  6. 6.

    Did you learn anything that you did not know?

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Maor, Y., Raz, M., Rubinstein, E. et al. Changing parents’ opinions regarding antibiotic use in primary care. Eur J Pediatr 170, 359–364 (2011). https://doi.org/10.1007/s00431-010-1301-9

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  • DOI: https://doi.org/10.1007/s00431-010-1301-9

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